Healthcare Provider Details

I. General information

NPI: 1407493448
Provider Name (Legal Business Name): BROOKE ALICIA WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

48 PAYSON HILL RD
RINDGE NH
03461-7818
US

V. Phone/Fax

Practice location:
  • Phone: 978-322-8665
  • Fax: 978-221-6214
Mailing address:
  • Phone: 978-621-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: